Racial differences in patient perception of interactions with providers are associated with health outcomes in type II diabetes

Abstract

Objectives: Examine the association of patient perceptions of care with hemoglobin A1c (HbA1c), medication adherence, and missed appointments in non-Hispanic Black (NHB) and White (NHW) patients with type 2 diabetes (T2DM).

Methods: We used linear and logistic regression models to analyze the association of the Interpersonal Processes of Care survey (IPC) with HbA1c, medication adherence, and missed appointments. We then examined how these associations differed by race.

Results: There was no overall association between IPC subdomains and HbA1c in our sample (N = 221). NHB patients perceiving their provider always explained results and medications had a HbA1c on average 0.59 (-1.13, -0.04; p = 0.04) points lower than those perceiving their provider sometimes explained results and medications. No effect was observed in NHWs. Never perceiving disrespect from office staff was associated with an average 0.67 (-1.1, -0.24; p = 0.002) point improvement in medication adherence for all patients. Never perceiving discrimination from providers was associated with a 0.44 (-0.63, -0.25; p < 0.0001) decrease in the probability of missing an appointment for NHB patients.

Conclusions: These results demonstrate that particular aspects of communication in the patient-provider interaction may contribute to racial disparities in T2DM.

Practice implications: Communication training for both providers and staff may reduce disparities in T2DM.

Keywords: Glycemic control; Healthcare disparities; Medication adherence; Patient-provider interaction; Provider communication; Racial disparities; Type II diabetes.

Figure 1:. Patient Recruitment (color print online only)

This figure demonstrates the selection and recruitment process for our patient sample. Partially eligible patients met all eligibility criteria except prescription of ≥1 antihyperglycemic medication and were therefore included in analyses of HbA1c and missed appointments but not medication adherence. One patient completed the IPC survey but not Extent of Medication Adherence Survey (“eligible consented patients who did not complete all survey instruments”) and two patients consented but did not complete surveys (“eligible consented patients who did not complete survey”).

Figure 2:

Relationship between specified IPC subdomains and HbA1c by race * Adjusted for age, gender, race, length of relationship with provider, education, and financial security

Figure 3:

Relationship between disrespectful office staff and medication adherence by race * Adjusted for age, gender, race, length of relationship with provider, education, financial security, and route of antihyperglycemic medication administration.

Figure 4:

Predicted probability of missing an appointment for specified IPC subdomains* *Adjusted for age, gender, race, length of relationship with provider and education